Digestive and Gut

Diarrhea is a symptom of some underlying disturbance of the gastrointestinal tract (gut), particularly the intestines. There are many diseases that present with diarrhea and on its own, it is difficult to identify the exact cause of diarrhea. Other symptoms need to be taken into consideration or tests may be necessary to identify the cause of the diarrhea.

Although most of us see diarrhea as very frequent or loose and watery stools, there definition in a bit broader. Sometimes in severe cases, diarrhea may be almost “explosive”. The passing of stool can seem “violent”, erupting with force and at times messing the toilet bowl extensively. Understanding some of the causes of explosive diarrhea is important as sometimes even the most harmless causes can present with violent bowel movements that may be concerning to a person.

Diarrhea is less common than constipation in pregnancy. However, it may occur for the same reasons as diarrhea in non-pregnant women as well as being a consequence of the elevated hormone levels associated with pregnancy. Diarrhea in pregnancy should always be monitored closely by a medical professional as it can lead to complications that may threaten the fetus and jeopardize the pregnancy if it persists beyond two days. The greatest danger in this regard is dehydration, however, with infectious causes there is also the risk associated with fever and a spread of the infection. Sometimes diarrhea occurs early in the first trimester along with nausea and vomiting (‘motion sickness) but should not be considered as a sign of pregnancy. However, diarrhea in later pregnancy may be a sign of impending labor.

Diarrhea is a symptom of underlying gastrointestinal dysfunction. It is defined as the passage of more than 200g or 200ml of stool in three or more bowel movements within a 24 hour period. Typically there is a large volume of watery stool especially in acute diarrhea. Sometimes changes in bowel habit and stool form may not fit into the definition of diarrhea yet it is not normal for the individual. Frequent bowel movements and loose stool are two more commonly used terms to describe these changes but may be used quite subjectively. Irrespective of the terminology, the changes are due to certain known mechanisms.

The bowels are made up of the small intestine and large intestine which are the longest parts of the digestive tract (alimentary tract or gut). The intestines are important sites of digestion and absorption of nutrients and the formation of waste material that is evacuated from the bowels as feces. Like the rest of the gut, it has a multi-layered wall that is somewhat similar in structure from mouth to anus. Within the bowels are massive populations of bacteria which help with digestion and absorption of nutrients but usually do not harm the bowels. This naturally-occurring ‘good’ bacteria is known as the normal intestinal flora. The bowels are affected by a number of insults, from infectious to mechanical and chemical, but is usually able to recover once the causative factor is removed.

The use of terms such as gastritis, peptic ulcers, acid reflux and gastroesophageal reflux disease (GERD) can sometimes be confusing for the average person. It often leads to a person wrongly attempting to self-medicate themselves with over-the-counter (OTC) products, sometimes without even the advice of a pharmacist. In order understand the differences and similarities between these conditions, it is important to first have a basic understanding of stomach anatomy and physiology.

The stomach is a hollow organ that connects with the esophagus (food pipe) at the top and small intestine towards its bottom end. It has specialized cells in its lining that secretes mucus, enzymes, hydrochloric acid and water. This creates the stomach juices, collectively referred to as the stomach acid, helps with the process of digestion. A mucus barrier protects the lining from the corrosive action of the gastric acid. Food that enters through the mouth passes down the esophagus, is churned in the stomach and partly digested by the acid and enzymes and then passed on to the small intestine for further digestion and nutrient absorption.